Jejunum Ileum

JEJUNUM and ILEUM Dr. Aldwin A. Yaneza Dept. of Anatomy

Jejunum and Ileum 

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Jejunum starts at duodenojejunal flexure 6-7 m long 2/5 jejunum, 3/5 ileum Coiled Covered by greater omentum No clear line of demarcation Localization is of surgical importance

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No clear line of distinction between the two parts. But important to recognize either segment, especially in performing gastrojejunostomy or tube jejunostomy for feeding.

Jejunum       

Latin jejunus = EMPTY Often empty Thicker More vascular Redder Lies in umbilical region Circular folds [ plica circulares or valves of Kerckring] of mucous membranes are large and well developed

Ileum    

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Thin Less vascular Less red Lies in hypogastric and right inguinal region Plicae circulares are small in superior ileum and absent in terminal ileum Lymph follicles are aggregated as Peyer patches located at the antimesenteric side Site of an outpouching called Meckel’s diverticulum Ends at ileocecal junction

Meckel’s Diverticulum

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Most common malformation of GIT In 1 -2 % of popln Fingerlike pouch Remnant of embryonic yolk stalk Same layers as wall of ileum May contain gastric epithelium and secrete acid cause ulcer 3 -6 cm long Fr antimesenteric border of ileum Within 50 cm of ileocecal junction When inflammed , mimics acute appendicitis

MESENTERY

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Double layer of peritoneum w/c encloses an organ and connects it to abdominal wall Contains fat, lymph nodes, BV, nerves going to viscus Named after viscus it attaches    

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Most mobile parts of intestine 

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Stomach – mesogastrium Transverse colon – transverse mesocolon Sigmoid colon – mesosigmoid Ovary - mesovarium Transverse colon, small intestine

None in retroperitoneal viscus 

Ascending colon , kidney, parts of duodenum

Mesentery

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Suspends jejunum & ileum Fan shaped Root [ 15 cm long ] is directed obliquely, inferiorly, and to the right Root crosses the ff struc      

Duodenum,3rd part Aorta IVC Psoas major Right ureter R gonadal vessels

Mesentery 

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Consists of 2 layers of peritoneum Bet are jejunal and ileal bld vessels,lymphatics, nerves Less fat in mesentery of jejunum Prominent arterial arcades in jejunum

Arterial supply

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Superior Mesenteric Art or SMA Branches: Jejunal artery Ileal artery Arterial arcades  

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Arteries in mesentery unite Shorter/more complex in ileum

Vasa recta 

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Straight vessels w/c arise fr arterial arcades Longer in jejunum Shorter in ileum

Venous drainage 

Superior Mesenteric Vein or SMV  Accomp SMA  Crosses duod/ horiz.part and unicinate process  Terminates by uniting with splenic vein to become portal vein

Lymphatic Drainage Mesenteric Lymph nodes 3 locations: 1.Close to the wall of the intestine 2.Amongst arterial arcades 3.Along proximal part of SMA 

Nerve Supply 

Parasympathetic 

Vagus

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Stimulate:   

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increase motility of the bowel, increase secretion of intestinal gland vasodilation of blood vessels

Sympathetic 

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Superior mesenteric ganglion

Stimulate:   

reduce motility of the bowel reduce secretion of intestinal gland vasconstriction of blood vessels

JejunumHistology

Ileum- Histology

Peyers patches

Comparison Criteria Jejunum large  Diam thick  Wall many  Plicae 1-2  Art arc long  V recta less  Fat/mes feathery  Xray

Ileum small thin few many short more smooth

Code       

Ileum Denzel Diameter Washington Wall Plays Plicae A Arterial arcade Villain in Vasa recta X-rated Xray FilM Fat in mesentery

Jej * * * * * * *

Training Day

Breast of Eva Mendez

Future Cars

BIODIESEL 

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1% Coconut Methyl Ester + 99 % Petroleum. Biodegradable non-toxic free of sulfur and aromatics reduces serious air pollutants such as particulates, carbon monoxide, hydrocarbons

P40/li but unleaded is P42/li

Golf carts

Electric Power

Dodge Zeos

Chevrolet Volt

Volvo Recharge

Plug-in Prius Hybrid

Hydrogen Powered

Honda Clarity

Hydrogen fuelling station

Solar Cars

Water fuel car

Segment?    

No plicae circulares Near appendix Thin walled Answer: ILEUM

Segment?  

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Smaller diameter With diverticulum[arr ow] Answer: ILEUM

Segment?    

Larger diameter Thick wall Redder Answer: JEJUNUM

Segment?  

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Thick wall Prominent plicae circ Answer: Jejunum

Segment?  

Encroaching fat Ans: ILEUM

Segment  

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Large diameter More on upper abdomen Thick walled Ans: JEJUNUM

Clinical Correlation 

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A 34 yo,male, was rushed to the ER for stab wound at right lower quadrant. He had eviscerated intestine [which has numerous arcades and short vasa recta] from the SW site [ 4 cm]. What is this segment? ILEUM

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A 34 yo M was admitted for anal bleeding Endoscopy [inserted into anus]was immediately performed which saw the bleeding segment about 4 cms distally from the cecum and where the mucosa is smooth and not thrown into folds. Diagnosis?What is the bleeding segment? Lower GI Bleeding Ileum Lower GI Bleeding 2 to ileitis

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A 18 F will undergo surgery for bleeding diverticulitis. Where is the location? Where[quadrant] will you place the incision? What structures will be encountered? Ileum Right lower quadrant Structures Skin  Subcutaneous, Fascia  EO, IO, TA  Parietal peritoneum 

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A 86 F with stroke and unable to swallow is scheduled for insertion of a feeding tube jejunostomy. Where will the surgeon make the incision? How will he know if the segment he grasped is the JEJUNUM? Left upper quadrant Thick walled Larger diameter Few arterial arcade Long vasa recta Less fat in the mesentery

ILEOSTOMY

Dilated jejunum

Sutures after resection and anastomosis

Gastrojejunostomyconnect the jejunum to the body of stomach jejunum

Body of

GI TB

Segment? 

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Clue 1: The small intestine was adherent to the uterus Clue 2: My incision was below the umbilicus Answer: ILEUM

Prepare for Quiz Set A first

Quiz Set A 

Tabulate the 7 differences between jejunum and ileum.

Quiz Set B       

1. What is the arterial supply of small intestines? 2. What is the venous drainage? 3. What are the nerve supplies? 4. What are the actions of No 3? 5. Where are the lymph nodes located? 6. How do you call the mucosa of the jejunum thrown into folds? 7. What is a Meckels diverticulum?